Consumer Perceptions and Behaviors towards Online Pharmacies

Dr. Anne Snowdon, Academic Chair, World Health Innovation Network

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T W O M E T H O D O L O G I E S

- Two surveys (telephone and online)

- Telephone survey: 1,287 randomly selected adult Canadians (>18 yrs., April 12th – May 2nd, 2018). Margin of error = 3.1% at 95th

confidence interval

- Online survey: 1,635 adult Canadians to examine more in-depth perceptions and behaviors (April 19th – 27th, 2018).

- Results were weighted to n=1,000 by age, gender and region based on latest census data

Methodologies

Telephone Sample

The telephone survey serves as a reference study and established the true incidence rates within the Canadianpopulation. The online data are weighted by the telephone results to better reflect a random-probability sample representative of the Canadian population.

Weighted Online Sample

The results from this random-probability sample accurately reflect the incidence rates among the Canadian population (within a statistical margin of error).

The telephone results for prescription medication use, awareness of online pharmacies, and purchase experience are used to create a weight by which the online data are weighted.

The online sample is weighted by prescription medication use, awareness of online pharmacies, and purchase experience to reflect the results of the random telephone sample and to better represent these metrics for the Canadian population.

3

Weighting Segmentation for Online Survey

28%

36%1%

17%

17%

0%

Usage and familiarity segmentation of Online Data(based on telephone data)

Prescription and unfamiliar (28%)Prescription and purchase (1%) No prescription and familiar (17%)

Prescription and familiar (36%)No prescription and unfamiliar (17%)No prescription and purchase (0%)

The online data was weighted to reflect theincidence rates established in thetelephone survey forprescriptionmedication use, awareness of onlinepharmacies, andpurchase experience.

These variables were combined to create ausage and familiarity segmentation and to align the online data with the telephonedata.

1%of respondentshave purchased

from online pharmacies

4

British ColumbiaUnweighted n=310

Weighted n=141

AlbertaUnweighted n=195

Weighted n=108 Atlantic Unweighted n=92

Weighted n=73Ontario

Unweighted n=634Weighted n=386

Prairies Unweighted n=82

Weighted n=58

Quebec Unweighted n=322

Weighted n=236

Regional groupings include:▪ British Columbia (Yukon)▪ Alberta (Northwest Territories)▪ Prairie Region (Manitoba, Saskatchewan and Nunavut)▪ Ontario▪ Quebec▪ Atlantic (PEI, New Brunswick, Nova Scotia and Newfoundland & Labrador)

Where did respondents come from?

National Sample (Online) n=1,000Unweighted n=1,635

5

33%27% 25%

Demographics: Respondent Profile

<$60KNote: 15% prefer not to say

$60K-$100K $100K+

Gender and Age Household Income

Online Shopping

15%17%15%15%19%18%

M 18-34

M 35-54

M 55+

F 18-34

F 35-54

F 55+

48%

52%

Prescription Coverage

23%

57%

17%4%

Yes, all of it iscovered

Yes, some of it is No, none of it is covered covered

Don’t know

11%

26% 22%30%

10%2%

About once a About once aweek month

Between 6and 12 times

a year

Fewer than 6times a year

Never Don’t know

6

Prescription Medication: Over half (52%) ofrespondents take prescription medication

Do you, or does someone in your household, currently take any prescription medication? Please select all that apply.[multiple mention: percentages do not add up to 100; asked of all respondents, n=1,000]

Q

52%

33%

Yes, I do Yes, someone else in myhousehold does

No, no one in myhousehold does

Don't know

Note: 1% prefer not to say

SegmentationThose who live in households with prescription medication

Age/Gender

66% of respondents live in households in which at

least one member currently takes prescription drugs

26% 1%

59%58%

80%58%58%

82%

Male 18-32Male 35-54

Male 55+Female 18-34Female 35-54

Female 55+

Region

57%7%

81%3%0%

7%

BCAlbertaPrairiesOntarioQuebecAtlantic

Income

62%66%

$100K+$60-$100K

<$60K

69%

Extended Benefits

49%

65%

No CoveragePartial Coverage

Complete…72%

7

Awareness of Online Pharmacies: Just over half (55%) of respondents know that online pharmacies exist

The following questions are about online pharmacies. An online pharmacy is defined as a pharmacy that operates over the internet and sends the orders to customers through the mail or shipping companies. Please note that this does not include online pharmacy services, such as refilling orders.To what extent were you aware of online pharmacies before this survey?[asked of all respondents, n=1,000]

Q

2% 4%

49%

42%

I have experiencepurchasing fromonline pharmacies

I have looked into online pharmacies

and understand how they work

I know that online pharmacies exist, but I don’t know

much about them

I had not heard ofonline pharmaciesbefore this survey

SegmentationThose who say they at least knowonline pharmacies exist

Age/Gender

55%At least know online pharmacies exist 41%

63%68%

42%54%

62%

Male 18-32Male 35-54

Male 55+Female 18-34Female 35-54

Female 55+

Region

58%61%59%56%

52%44%

BCAlbertaPrairiesOntarioQuebecAtlantic

Income

55%54%

$100K+$60-$100K

<$60K

57%

Extended Benefits

52%

56%

No CoveragePartial Coverage

Complete…56%

8

98%

1% 1%

No Yes Don’t know

Purchase History: Only 1% of respondents have bought prescription medication online

Thinking of all the prescription medication you purchase for yourself or your family, how much of it do you purchase online?

medication from an online pharmacy, n=13]

Q

n=3

n=5

n=5

All of it

At least half of it

Less than half

Have you ever purchased prescription medication, either for yourself or a family member, from an online pharmacy?

heard of online pharmacies before, n=1,000]

Q

Note: Very small n-size. Interpret with caution.

Thinking of the last time you ordered from anonline pharmacy, which of the following bestdescribes that pharmacy?[asked of respondents who have purchased prescription medication from an online pharmacy, n=12]

Q

n=9It appeared to be located in Canada and affiliated with a

storefront pharmacy

It appeared to be located in Canada but not affiliated with

a storefront pharmacy

I don’t know where it waslocated.

n=2

n=1

9

Openness to Purchasing: Young people (18-34) are most open to purchasing from online pharmacies

The next time you need prescription medication, either for yourself or a family member, how likely would you say you are to purchase it froman online pharmacy?[asked of all respondents, n=1,000]

Q

3%

12%

23%

Very likely Somewhat likely Somewhat unlikely Very unlikely Don’t know

SegmentationThose who say likely

Age/Gender

54%

15%Likely

28%8%

3%33%

15%6%

Male 18-32Male 35-54

Male 55+Female 18-34Female 35-54

Female 55+

Income

15%15%

$100K+$60-$100K

<$60K

20%

Extended Benefits

10%No CoveragePartial Coverage

Complete…15%

19%

10

Openness to Purchasing by Online Shopping: Frequent online shoppers most open to online pharmacies

“Thinking about online shopping in general, which of the following best describes how often you purchase products online?”

Column % About once a week

About once a month

6 to 12 times a year

Fewer than 6 times a year

Never

Very likely9% 4% 2% 1% 1%

Somewhat likely24% 18% 12% 6% 6%

Somewhat unlikely 22% 29% 28% 20% 14%

Very unlikely 35% 41% 51% 67% 76%

Total likely 32% 22% 15% 7% 7%

Total unlikely 57% 70% 78% 87% 90%

Note: Don’t know not shown.

11

Openness to Purchasing: Non-prescription drugs are most likely to be considered for online purchase

Of the following types of medicine, which have you purchased online? PAST BUYERS [asked of respondents who have purchased prescription medication from an online pharmacy, n=13]

Of the following types of medicine, which would you consider purchasing online? POTENTIAL BUYERS [asked of all respondents who were likely or only somewhat unlikely to purchase from an online pharmacy, multiple mention, n=386]

Q

52%

36%

33%

31%

31%

16%15% [n=2]

14%

11%

14%

36%

40% [n=5]

43% [n=5]

19% [n=2]

27% [n=3]

29% [n=4]

2%

6% [n=1]

Over-the-counter medicines that don’t require a prescription such ascough, cold, allergy, or pain reducers

Lifestyle drugs (e.g. weight loss aids, birth control, drugs for erectile dysfunction, drugs for focus and energy, vitamins)

Prescribed medicines for chronic, ongoing conditions such as bloodpressure and cholesterol, diabetes, COPD

Prescribed medicines for acute, short-term issues such as infectionsand insomnia

Medications for the treatment of chronic pain

Prescribed specialty medications for things such as cancer andhormone replacement therapy

Cosmetic drugs (e.g. Botox, drugs that prevent balding)

Other

Don’t know

I would not consider purchasing medicine online

Potential buyers (n=386)

Past buyers (n=13)

Note: Very small n-size for past buyers. Interpret with caution.

[n=5]

12

Who Would Consider Which Medicine? Young womenmost likely to say non-prescription and lifestyle drugs

Column % Total Male 18-34

Male 35-54

Male Female55+ 18-34

Female 35-54

Female 55+

Over-the-counter medicines that don’t require aprescription such as cough, cold, allergy, or painreducers

52% 59% 38% 23% 71% 52% 34%

Lifestyle drugs (e.g. weight loss aids, birth control,drugs for erectile dysfunction, drugs for focus andenergy, vitamins)

36% 42% 28% 17% 54% 38% 10%

Prescribed medicines for chronic, ongoing conditions such as blood pressure and cholesterol, diabetes, COPD

33% 41% 31% 22% 30% 33% 26%

Prescribed medicines for acute, short-term issuessuch as infections and insomnia 31% 42% 25% 13% 32% 36% 16%

Medications for the treatment of chronic pain 31% 42% 30% 24% 31% 26% 19%

Prescribed specialty medications for things such ascancer and hormone replacement therapy 16% 19% 17% 6% 14% 22% 11%

Cosmetic drugs (e.g. Botox, drugs that prevent balding) 14% 22% 9% 6% 17% 14% 6%

I would not consider purchasing medicine online 14% 5% 12% 29% 8% 20% 24%

Note: Purchase considerations were asked of all respondents who were likely or only somewhat unlikely to purchasefrom an online pharmacy, multiple mention, n=386. Don’t know not shown.

13

Regulation: Pharmaceutical and pharmacy industriesexpected to play a role in online pharmacy regulation

In general, do you agree or disagree with the following statements?[asked of all respondents, n=1,000]Q

70%

65%

53%

29%

14%

17%

23% 7% 13%%

27%

35%

20%

6%2%32%

11%

21%

24%

7% 5%

14% 10% 18%

The pharmaceutical and pharmacy industries should monitor online pharmacies for safety

and compliance with Canadian laws

Before purchasing medication from any online pharmacy, it is important to look for details

regarding company location, company ownership, and customer testimonials.

The government should get involved to regulate the sale of prescription medication online

Canadians should have the option to purchase their prescription medication online

I trust that online pharmacies selling to Canadianscomply with Canadian laws and standards.

Strongly agreeNeither agree nor disagree

Somewhat agree Somewhat disagree

84%

87%

74%

51%

10%

Net agreement

4%

3%2%

4%

13%%

14

Perceived Benefits: Convenience and lower Cost are the largest perceived benefits of online pharmacies

Based on what you’ve heard, or perhaps your own experience, what would you say is the main benefit of purchasing from online pharmacies? Would you say:[asked of respondents, n=1,000]

Online ordering is convenient 35%

Lower prices than storefront pharmacies 27%

Q

3%

3%

2%

2%

1%

1%

11%

15%

The ability to get access to certain prescriptiondrugs without a prescription

The ability to get access to a greater choice ofmedications

The ability to get access to medications that arein short supply in Canada

The ability to stay anonymous

Not having to talk to a pharmacist

The ability to try different medications to see if they work better than what is prescribed

None

Don't Know

15

Perceived Risks: Receiving wrong or counterfeit/tainted medicines are the greatest concerns when buying online

Based on what you’ve heard, or perhaps from your own experience, what would you say is the biggest risk of using online pharmacies?[asked of respondents, n=1,000]

Being sold counterfeit and/or tainted medicines

Q

36%

16%

15%

5%

4%

4%

3%

2%

1%

3%

9%

Risk of getting the wrong medication

Being sold unapproved medicines

Risk of private information being sold to thirdparties

Risk of physical harm

Risk of being financially scammed

Risk of identity theft

Being sold expired medication

Lack of advice/guidance/in-personcommunication on use

None

Don't Know

16

Overall Risk: 58% view it as risky and not work the risk, young people more likely to take the risk

When it comes to ordering from an online pharmacy, how risky do you think it is?[asked of respondents, n=1,000]

Q

8% 10%

58%

24%

Not risky Risky but worth the Risky and not worth risk the risk

Don’t know

SegmentationThose who say risky but worth the risk

Age/Gender

22%10%

3%15%

9%4%

Male 18-32Male 35-54

Male 55+Female 18-34Female 35-54

Female 55+

Region

11%7%

10%10%10%11%

BCAlbertaPrairiesOntarioQuebecAtlantic

Income

10%11%

$100K+$60-$100K

<$60K

12%

Extended Benefits

8%No CoveragePartial Coverage

Complete…9%

14%

17

Split Sample: Question order

Sample A[n=479]

Sample B[n=522]

Research by the National Association of Boards of Pharmacy has found that there are between 30,000 and 35,000 online pharmacies operating at any one time. That research reports that more than 96% of them are operating illegally, failing to comply with applicable laws and safety standards, and approximately 12% of these sites sell controlled substances. Were you previously aware of this?

1

People have varying opinions about the role the2 Canadian government should play when it comes to

online pharmacies. Please indicate how importantyou think each of the following types of government involvement is for protecting Canadian consumers.

To the best of your knowledge, is buyingprescription medications online…3

Research by the National Association of Boards of Pharmacy has found that there are between 30,000 and 35,000 online pharmacies operating at any one time. That research reports that more than 96% of them are operating illegally, failing to comply with applicable laws and safety standards, and approximately 12% of these sites sell controlled substances. Were you previously aware of this?

3

People have varying opinions about the role the Canadian government should play when it comes to online pharmacies. Please indicate how important you think each of the following types of government involvement is for protecting Canadian consumers.

1

To the best of your knowledge, is buyingprescription medications online…2

18

Awareness of Research: Clear majority was unaware ofthe research regarding illegal online pharmacies

Research by the National Association of Boards of Pharmacy has found that there are between 30,000 and 35,000 online pharmacies operating at any one time. That research reports that more than 96% of them are operating illegally, failing to comply with applicable laws and safety standards, and approximately 12% of these sites sell controlled substances. Were you previously aware of this?[asked of respondents, split sample]

Q

1%

14%

83%

1%

Yes, I was fully aware

I was somewhat aware, but

didn’t know allthe details

I was notaware of thesefacts until this

survey

Don’t know

2%11%

84%

3%

Yes, I was fully aware

I was somewhat aware, but

didn’t know all the details

I was notaware of thesefacts until this

survey

Don’t know

Shown this question first[n=479]

Shown this question second [n=522]

19

Regulation: Efforts to regulate online pharmacies and close illegal operations seen as most important

People have varying opinions about the role the Canadian government should play when it comes to online pharmacies. Please indicate how important you think each of the following types of government involvement is for protecting Canadian consumers.[asked of all respondents, split sample]

Q

61% 23% 11% 2%

57% 24% 14% 2%

66%

59%

39%

29%

63%

58%

22%

27%

36%

36%

26%

27%

8% 2%

9% 3%

17% 4%

24%

8%1%

9% 3%

6%

Shown Research First

Shown Research Second

Shown Research First

Shown Research Second

Shown Research First

Shown Research Second

Shown Research First

Shown Research Second

Absolutely critical Very important Not very important Don’t know

Somewhat importantNot important at all

Taking a firm position with foreign governments whereonline pharmacies operate toensure illegal and unethicalonline pharmacies are closed

Setting national standards toregulate online pharmaciesselling to Canada

Sponsoring educationand awareness programs

Making a greater effort to identify and prosecuteillegal online pharmacies operating in Canada

Note: Green highlighting indicate statistically significant differences (95%-level) in the percentage of respondents saying “absolutely critical.”

-7%

-10%

20

1. Just over half of Canadians (55%) have at least heard of online pharmacies, but veryfew (1%) have purchased from online pharmacies before.

2. About 1-in-6 respondents (15%) say they are at least somewhat likely to purchasefrom online pharmacies the next time they need a prescription medication. Non-prescription drugs are most likely to be considered for online purchase.

3. Pharmaceutical and pharmacy industry, as well as government are expected to playa role in online pharmacy regulation.

4. Convenience and lower prices are the largest perceived benefits of online pharmacies,while receiving wrong or counterfeit medicines are the biggest concerns when buyingonline.

5. Canadians know little about online pharmacies and their legal status in Canada.While Canadians generally place a high priority on government action to protectCanadians using online pharmacies, that priority increases when respondents learnabout compliance issues with existing online pharmacies.

Key Findings21